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AF - 43055�, Date Owner Addres �UILDING PERMIT `�il�age of �ridley, l�'Iinn. �� 2 2 4 2 � ��,��' / .�� .................... ... .,..�` . ........ � ........... . .:... ..�� Bui2der .... ..................................... � .�?� �_f� *� s .. . . . . . . �.�r"':!'�.'�'��".r�`� Address .. .. .. .. .. .. . . .. . . . . .... . . . . . . .. .. .... ... ATION �BUILDIiVG No. ...�.�.�.� Street .......� .......................... . Part of Lot ....................... Lot . . . . . �. :µ!. . . . . . Block . . . . . . . . . . . . . . . . Addition or Sub-Division � `�. �� . . . . . . . . . . . . � r, ' � Corner Lot . . . .. .. . . . Inside Lot . . . . � Setback . . .��. .�. . . . . . Sideyard . ". .� . . .� . . � �, DESCRIPTIOI�I OF BUILDiNG 7'� ^be Used as: �,,� ,�j �" ,�-'"f�. : '#:�:"'� ' _�� . Front . .. ,l. �.+.� Depth . .�"��€. �. Height .�r'`�``.�' Sq. Ft. . . . . . . . . Cu. Ft. . . . .. .. , �"'°°f e ,q,�} ,6;;y,.+��'s''t.� � r � #.,� '�"_"• `,r+F r.✓✓,: . . . ��'. .. .. . . . Frbnt . .. . . . Depth . Height . .. .. .,,,....: Sq. Ft. . . . . . .. . Cu. Ft. . . . .. .. . ..t`,. � `"`- T e of Construction .�:?:�. .��:�`:':"� Est. Cost� i�.�.`.�. .. . . To be m 1 t ... YA �� ... .. ... .... Co p e ed ................ ��+'�� '1�� «�. � � J� t � ��'� � ,.��-� �' In consideration of the issuance to me of a permit to construct the building ' d above I agree to do the pmposed work in accordance with the description above set for an 1' with visions of ordinances of the village of F'ridley. �y"W N � . .. . . � ..... ... .....�.. In consideration of the payment of a fee of $. ...! a' � permit is hereby granted to . ..... . .., ....................... to construct the building or addition as described above. This'.permit'�is granted upon the express condition that the person to wham it is granted and his, agents, employees and workmen, in all work , done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of �'ridley, Minnesota regarding location, construction, alteration, mainteriance, repair and moving of buildings with- in the village limitis 3nd this permit may be revoked at any time up ;violation of any of the provisions of said ordinanCes. ' ...... ..! .. .. ilding Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building InspeCtor for separate permits for these items. ,:�:. �: City of Fridley, 1Vlinn. BUILI)ING PER,MIT N� 52i 3 Date ._.��'..""..:! .�"'w"_!�._'_�_..._...._..._._.._____...___.._ s'� � . Owner: ..:� ,� •,+�; . Builder .. _ . • -•-•--_.._. .......'�•• ---- •• ----�� .._ --- ._......._..._..__ Address•-----.....-----_...---_•-.__..-----.____.._._. •----..... Address LOC�4T F BUILDi(e!G �,'f"�6.-�" . No. ... ..... ._ �.�. .. Street ... . .._ ' ' '� -----:_ .............. Part of Lot ..__......._--�---.._.._. Lot _.._.._...._.._...:.---•-._ Block _..._.__...__--•---•----•--- .............._ Addition or Sub-D'vision ....._..........__._..._..._.....__. • - • ----. ..--- Corner Lot .---_.....--.--.._......_ Inside Lot .------..:.------.....�......----..+�tback t.""�:_�. ..._...: Sideyard .` _,......_---------• Sewer Elevation _...__.....�--•----------_.---.._..-----�.__.-----.....---••---- Fo dation Elevation .-------....-------...------------ r DESCRIPTlON OF 6UILDItVG T e Us � ,� s �'.�•��- +�'�------��f ont "' ` � j, r � � -�, ,r� �� ...�.�'.. Depth .,�' .� _..___ Height ....t....!.,�...... Sq. Ft. ,� -�` -;�-•--- Cu. F� -.-�..; �� t ._ ••--._ .............---...._...._.._................. Front .- -- Depth ..... - Height --... . Sq. Ft. _............-----_.. Cu. Ft. -- --- _. - ---•-�----��----- _. ,- �, ,�;, �'. Type of Constsi.iction .. :.-- ---�'-,c�,;�:`�%----- Est. Cos �.f...�. �;;!. '.�... To be Completed .. ----------------------. _. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. �_.___.__�..___ In consideration of the a p yment of a fee of $_.. ...._.....__.., permit is hereby granted to._�._._ •••---•••-•�—•-•----•-------......._....___ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done m, around and upon said building, or any pax�t thereof, shali eonforrn in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration; maintenance, repair and moving of buildings Within the city limits and this permit may be revoked at any ti viol ion of�.,v of the provisions of said ordinances. �� 1 � '-�uilding Inspector NOTICE: ` This permit does not eover the consfruetion, installsfion for wiring, piumbing, gaa heating, sewer o� water. Bs suro fo see fhe Building Inspeefor for separete permits for these ifema. 4 APPLICATION FOR BIIILDIPTG PF�MIT CITY OF FRIDLEY, MINNESOT9 r Y 4wner's Name � ��C�-� �, � � Builder--- ��-`� �i 7- '`�'�3�-•� �ddress LOCATION OF BUILDING I3o. Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setba.ek Side-Yaxd SEWE�. ELEVATTON FOUNDATION ELEVATION !€pplicant attaeh to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILUING To be used as : ' � /�-"'ri^^' -`'� ��-�X.� U c�-�� /� 0 Front��,rDepth l He3ght � Sq. Ft. ,.,,� � � Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. � Type of Conatruction Eatimated Cost ,,,�Q ��' �� f To be Completed _� - l� � � � - The underaigned hereby makes application for a permit for the work here3n specified, agreeing to do all Work in strict accordance with the City Qrdinances and ruling of the Department of Buildings, and hereby declaxes tha.t all the facts and representations atated in this application axe true and correct. ,� DATE � 1 � ?' 1 � / SIGNATUf� �-` �s�� / �..C'r1t�.�,._ (A Schedule of Fee Co9ta can be found on the Reverse Side.) .. . . ._ � • n � ' � �� ss �SS /�/� n ru ? � n � � � � � � � . -� G n � 1 C Sc' (� � n � � . . � - � � � tv ----� C—� G G �, sus�ecr PERMIT NO. City of Fridley -�"�"`-` AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � ` RECEIPT NO. / � ` _�_�_�_ COMMUNITY OEVELOPMENT DIV. .} .p -�" /� r � v � PROTECTIVE INSPECTION SEC. 1� 1 O I J i i � � /"'1 � CITY 1-IAL1. FRIDLEY 55432 NUMBER REY. OATE PAGE OF APPROVEO BY �""�'� �'' 612-571-3450 9� 0-F15 5/ 16 / 94 � � JOB ADDRESS 6476 Dellwood Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 10 Auditor's Subdivision SHEET 2 PROPERTYOWNER MAILADDHESS ZIP PHONE Phyllis Kachina 6476 Dellwood Drive NE - 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Advance Home Products 3770 West 521-9211 2332 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDFiESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Aluminum soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONS provide adequate attic ventilation. TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERM�TS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OF AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTEF WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEF SPEC�FIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1 s 7OO �. HS DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OT R STA OR LOCAL LAW REGULATING CON- STRUCTION O THE P RF RMA OF CONSTRUCTION. �39. OO 1.%O � PLAN CHECK FEE TOTAL FEE S�d 'l`� icense SC 5. 00 46. 55 IGNATUAE OF CONTRACTOR OR AUTHOA�2ED AGENT IDATEI H PR ERLY ALIDATED THIS IS YOUR � RMIT � �r� SiGNATURE OF pWNEA iiF OWNER BU4DER1 �DATE� BLDG � OFTE NEW ADDN ALTER f1 [1 �1 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1/ 1 J94 �( ��S Construction Acidress: �v ��c�1%r.v� a � ,�F ,' �2 /i�� — -- _ Legal Description: Owner Name & Address: Contractor: A�u�� Adciress: � 7 �r� - LIVING AREA: GARAGE AREA: DECK AREA: OTHER: � S ��c �� w p k 3 �� e Tel. # S7/ �!/s�G MN LICENSE # OC��33� a Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Tel. # ,S-d/- %�1� Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: ��„�,,, ; N�4,, So�-�� u ra Estimated Cost: $/74 o e v Approx. Completion Date: - t S j5� (cost on Backj Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee 5ewer Main Charge TOTAL IT O LY _$ Tel. # $ ;� f,� C� Fee Schedule on Reverse Side $ / - '% � .001 of Permit Valuation (1 / lOth %) $ j ��S^ $.50/$1,000 Valuation $ $800 per SAC Unit $ 5- C? C� $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] � ��.. 5� STIPULATIONS: �� ; sue�ecr .P City of Fridley 27 5 6 6 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T f 1 1 � L - � • COMMUNITY DEVELOPMENT DIV. � ; V �� , r � � PROTECTIVE INSPECTION SEC. 1 � ( � �'��1 � CITY HALL fRIDLE� 55�32 NUMBER REV DATE PAGE Of AVPpOVEO B� �'""'� � ,�� 612-571-3450 910-F15 � � 9/3/98 JOB ADORESS 6476 Dellwood Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED DESCR. Pt.10 540 Auditor's Subdivi 1011 8 SHEET 2 PROPERTY OWNER MAII ADDRESS ZIP PHONE Ph llis Kachina - 3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO. Advance Home Product - d ARCHITECT OR OESIGNER MAIL ADDRESS ZiP PHONE LICENSE NO. 5 ENGtNEER MAII ADDfiESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WOHK ❑ NEW ❑ ADDITION ❑ ALTERATION X� REPAIR O MOVE O REMOVE 8 DESCFIBE WOFiK Reroof house an - 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRtCAL, PLUMBING, HEATING, VENTIIATING OR AIF CONDITIONING. THIS PERMIT BECOMES NUII ANO VOIO !F WORK OR CONSTRUCTION ZpNING S�. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANV TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING Of A PERMIT �Z�iOO 1. ZO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITfEE SACCMARGE PROVISIONS OF ANY O H STAT OR IOCAL LAW REGULATING CON- STRUCTION OR THE PE F M F CONSTRUCTION. �7�k.7S Fire SC �Z.�FO PIAN CHECK FEE TOTAL FEE License SC 5. 83.35 iG TUREOFCON� ACTORORAUTHORIZEDAGENi IDATE� WHEN PROPER VALIDATEO THIS IS VOUR PERM�T , < 'J � � SiGNATUREOFOWNEFiifOWNERBUILDERi �DAfEi BL G�NSP �i' E � NEW " ADDN ALTER �l �l � Construcdon Address: �( Legal Description: Owner Name �Yi, Address: Contractor; UaKc Address: 3 77 0- W� �' LIVING AREA: GARAGE AREA: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application __ � �.. Effective 1 / 1/95 '�el. # � 71— `�,L�6 MN LICENSE # oZ33� Tel. # S'.2.,/- �a/ / Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length W idth Height Length Width Height DECK AREA: Length OTHER: Width HgtlGroand � Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot (] Inside Lot ( j Ft. Yd Setback Side Yard Setbacks Type of Construcdon: '`a� �' s� � 4a� � o f f Estimated Cost: $� �-�-3-�..0 0 � Approx. Completian Date: �- � S- 9�' (Cost on Back). Driveway Curb Cut Width Needed: Ft. + b t= t x =$ DATE: � o'�/- °%� APPLICANT: Tel. # sa�-. y�a i/ Pernnit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ %`i %� � ,�. �d $ �. �� $ $ S Do $ $ $ $ TOTAL $ `�,3 • 3 S�- STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1 / lOth %) $.SO/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" At�ove $450.00 Conservation Plan Review Fee Determined by Engineering Agre�ment Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY tNSPECTION DIV. 6431 UniversRy Ave NE Fridley, MIV 55432 572— 3604 Water Stories Closet Urinal easemsnt ' . Floor 1 Floor 2 Floor 3 Fioor 4 . ` P4�MBiNC3 FIXTURE R�1TES APPLICA71pN FOR PLUM6lNC� AND CiAS FITTING PERMIT MARK NUMBER OF FIXTURES TO 8E INS7A�LED ON EACH FLODR 1�1 Wash qrtt�k. F►aor �a�c11 ' Auta� Shower Sink Tray �a�an�Drain ,�3aaih : Washer NO. RAl'E 70TAL New Fixtures Old Opening, Naw Fixtu�e Bee+' Oispenser Bfow ON 6asfn CatcA 8asin Rain Water Leader SumplRecelving Tank Water Treating Appllance Water Heater —�lectrfc Water H�ater — Gas•R � Gas Range** Gss Dryer"* Back Flow Preventer Required ()Yes () JVo �,ypg . $ 7.00 $ 4.00 $ 5.p0 $ 7.00 $ 7,Q0 $ 7,Q0 $ 7.00 $10.00 3 7.00 $�o,ao ,1�� $ t 0.40 $70.0� � $i 5.Q0 Reinspectfon Fee $42,OO,+Hr ALL O7HERS ANOJOR RCPAIl�S AND ALTERA'fiQ(YS 1.596 of Vatue of Fixture or Applianca �- � 8tate Surcharge TOTAL FEE $�_.54 Etfeciive On March t, 1998 Gas Mi3c. teater •' 'i��' � �r ��' � � � v �� The undersigned hereby makes appficatfan for a permR forthe work herefn spacified agreeing to do all work ln atrict accordance with the city codes and ruiings of the Building Division, and hereby dec�ares that a1J the facts and representations stated in this application are true and correct, � v , 1996 O�vner Buildini Estimated Cost � PlUM6iNQ COMPANY SI4NE� B�Cprd Approved By � `��'Uv pEpMt? NO. �� ///, ,._ „ (/D �>. / � - NO Rough—In Date Final Date MIIYIMUM r�t tvR ANY P�UMBlNC3/ s�� PLUS THE � 50 3TATE SURCHARGE •"COMSl1S110N AIA SHA�L BE PROVIDED PEA UMC SECi'ION 504(Aj AND TABLE 6—A. MINfMUM 512E 9 SQ INCHES. � m s J Q � � � . 9�'�,� l�'� � �� ti�1lu�� 3� . ��L> :,ITY OF FRIDLEY INSPECTION DIViSiON '�;��,,VV Effective On May 10, 1999 �431 University Ave NE =ridley, MN 55432 APPLICATION Ft)R POWER PLANTS AND HEATING, COOLING, VENTILATtON, �72•3604 REFRIG�RATION AND AIEt CONDITIONING SYSTEMS AND UEVICES � JOB ADORESS �-P��r �I �� `�; �:I��'+�'C�''� ��- � � �, RA�E SCHEDULE ' d OWNER�_�. � �S ��-�C.�� esidentiai Furnace Sheil and Duci Work, Burner - Also Replacement Furnace -� (Side Vent • Fill Out Back) �- Gas Piping (Needed with new furnace, 1 � but not replacement) � ',✓� � � � � �� u Gas Range. Gas Dryer 'Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST �N BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25%, of Value of Appliance or Work �ate $ 30.00 TOTAL � � ,� � r�� BUILDING USED AS �� ., ` ="- � " � �� -� �.��. `�' ..�' fI ESTIMATED COST � '�t� a�� PERMIT N0. ( C��I $ 10.00 $ DESCRIPTIQN OF_FURNACE AND OR BURNER $ 10.00 $ 1 G.00 $ 25.00 State Surcharge TOTAL �EE MWIMUM FEE FOR ANY HEATING/COOLING/ T�LATI N REFRIGERATION/AtR CONDITiONtNG PERMIT IS �25.00 PWS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr $ No. of Heatin Units�_ Circle Gne (Steam) (Ho Wate � arm Air) $ Trade Name ��' 1 l�r Size No. �� - -� STU ��' � C'�'��Y HP EDR $ Fuel ''�,1 ' � Total Connected Load � Burner Trade Name Size No. $ BTU HP EDR $ ' The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes ar $ .50 rulings of the Building Division, and hereby declares tF�at aq the facts and C- representations stated in this application are true and correct. � _`�� ,� � C� - - „��a�umr, u�. c ��tac� ; _ zs�� -�� i c� r� r� � C�hl RAPIOS. M'1 534� � HEATING � Signed� � /. %� �;,/. ` E- _� � ��c'� � ��. ' � � -��, � - - � 'Air Conditioners can not be placed in a side yard without Approved By/ Rough-In Date Final D written permission from adjoining property owner. __ __ ___ _.. ,._"_,�.�.A.. A.. ^� --------- - - ....,.� CHIlVINEY AND STACK VERIFICATION .-. The undersigned hereby verifies that the existing chimney or stack: 1. Has been cazefully examined Yes (�) No () 2. Is free from rust or deterioration Yes �). No (�'� ) 3. 4. ___ w 5� � Has no foreign objects lodged within Is s�curely supported Me�ts all current Code requirements for size and total BTU's connected � . Yes � No ( ) Yes �). <No ( - ) . 6 Has total heating BTU's of �`�� C�� "� All other BTU's ��%`� , �� ' �-� TOTAL BTU's' _[ � �� ; ��=� �--�--' 7. E:� Has a liner been provided for water heater Has combustion air been provided for water heater Remarks: 9 Yes �O No ( ) .` Yes �) No ( ) Yes OO No ( ) ,� a ist ALT�R�T Ol�[S Being Done: ?:. �� - � �n t„ �y �� : . . . . � � � f�.;1 . . 3Y. L FIEATING CO: Signed By: Date: � � � DEPENDABLE INDOORAIRGUALITY� INC. � Zs,s coor� w�os �vam =� COON RAPID3. AAN SS�133 �: � rs,2� �s�-soao � _ _ CCIYOF FRiDLEY FRIDLEY MUNICIPAL CENTER • 6431 LJNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 January 18, 2002 Ms. Phyllis Kachina 6476 Dellwood Drive NE Fridley, MN 55432 Re: Final Inspection at 6476 Dellwood Drive NE Contractor: Dependable Indoor Air Qualiry Inc Dear Ms. Kachina.: A mechanical pemut was issued on October 3, 2000 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date, no inspecrion has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for" and no further acrion will be taken. To set up the inspecrion or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh Building PLUMB�G Permit No.: � ��j� � ��`" Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 1�at��Q�: S E P 5 2 �8 763-502-4977 FAX E�c� ia.os DATE _��/ V� YOUR E-MAIL ADDRESS SITEADDRESS �e�[7(p �P I W�� I� � � --•-- � THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY NAME: % OWNER/ pDDRESS: CITY STATE ZIP TENANT pHONE: S � � �� CONTRACTOR NAME: SUBMIT A COPY OF STATE LICE um ing � EXP DATE YOUR STATE LICENSE, BOND AND STATE $ON �In . .�# 39 EXP DATE CERTIFICATE OF ADDRES : r� ey, 55432 CITY STATE ZIP � INSURANCE pHONE - 99 Fax (763) 754-2908 FAX PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW �REPLACEMENT DETAILED DESCRIPTION OF WORK �' l.eJ PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTUTtE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FEE $15.50. BATH SINK/LAV FLOORDRAINS SHOWER WATERPIPING BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KTfCHEN SINK WATERCLOSET BACKFLOW PREV. ($]5) DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER .�_-. E.._ ,, . .. ,,-.� 6__ �._ � ....-.. , , - v � _ . �_ x� , .... �g� r, .;, :_ � � . �_. � , �, x g �:�, _ a � ; ,,; .. .. < . , _. ,, _, _ . ,., Permit Fee $ � Number of fixtures @$10.00 x$10.00 =$ Surchar e .50 Number of fixfures @$15.00 x$15.00 =$ TOTAL DUE $ .� OR Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 (MINIMUM $15.50) (MINIMLIM $15.50 Tota1= $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LTNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all wor which re4uires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME N IG� ��,_ ��DATE ''�` �� APPROVED BY DATE �,:� , - „r:-=._:, -.-� `.::�- ,. . �_ . .. :: � � .-. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 /